"Who leads HIV prevention?"

Each month a new wave is ravaging Thailand killing more than both tsunami and terrorism. Actually, one on three (28,3 %) "active" homosexuals in Bangkok is HIV positive. Teenagers are officially recognized as a new raising high risk groups (but HIV incidence among these groups is kept undisclosed). And, irrationally, in the other hand, AIDS prevention is starving.

The HIV prevention crisis is not specific to Thailand. In fact, it concerns all countries in which the population is already aware of what we call " first-line messages ": what is AIDS and how HIV is transmitted (Thailand is comparable to that in most western countries) . In 2005, I spent a whole day in an European public health research center to analyze the AIDS prevention posters. I left the premises completely disturbed: in short, within the last 20 years, the "specialists" were only capable of delivering two main messages: " Do not stigmatize HIV-affected people " and the rules of " Safe Sex/abstinence ". Prevention seems mainly handicapped because of the lack of new ideas. It is strange since when we entered into the sphere of prevention, we discovered a new path that any newcomer could have found, theorized and exploited...

I personally accompany around 3000 AIDS patients to the final breath and I faced two paradoxes. The first: almost all my patients knew about HIV and how to protect themselves BEFORE they were contaminated! The second: almost all of them had the possibility to protect themselves! Yes, to say it in crude words: the condoms remained well wrapped in pockets when the viruses were shared. At the very worst, condoms were available for a quite affordable price at the nearby "7-Eleven" shop.

The same paradoxes were observed in West. Why were these people contaminated? Why? Just why?

Don't punish your brain trying to find an answer! They did not use condoms because they were too drunk, because they were too shy, because they were haunted by the inexpressible fear of impotence, because their lack of mental strength to take some extra time to go and buy them.

Where are the posters denouncing the strong links between alcohol and AIDS? Where are the posters helping to overcome shyness: too shy to ask to wear condoms or to buy them (This last issues may have been a bit more tackled recently)? Etc.

These prevention messages can be combined to create hundred other pertinent messages.

Look at this man: he drinks alcohol because he is anxious. He is forty-five years old and does not want to face the humiliation of impotence induced by this damned condom as he just starts a new relationship with an extra marital partner (sporadic impotence appears more frequently when starting a new relationship)! That drives us to another topic: adultery. This man, after being contaminated, will pass the infection to his faithful wife. He knows that he should protect her but now he does not wear a condom for another reason: he is scared because his wife (that he still love) will immediately guess that he had an extramarital affair. In fact, she already sensed the danger as nearly all faithful wives do. but this cursed adultery is now going to kill her! She was too shy to speak about it or, if it was not shyness, it was fear ? fear to hear the painful truth much more than the fear of his reactions!

Where were the posters telling her to distrust her husband despite the affection that she feels for him? Where were the magazines advising her about "how to help him to tell her the truth". T hese kinds of prevention messages should definitely be prioritized! To differentiate them from messages informing about HIV, we call them: " second-line" prevention messages because they are totally inefficient if they are not directed to people that already knows the basics about contamination.

In my opinion, it should be the duty of international organizations to assemble the existing materials from all around the world, to elaborate new theories and to suggest the most adapted materials to each concerned health ministry for national implementation after cultural adaptation. Only such organizations have enough "altitude" to do that. When the World Health Organization, criticized Thailand ("The Nation"; August, 20, 2005), did they offer some CONCRETE solutions?

The HIV prevention, which has had to face the rules of modesty and decency, must now attack these men who refuse to use condoms with hundred of dull arguments as they do not want their partners to know about their mediocrity. It is time to vigorously challenge the man who says that he does not feel anything when using a condom. Such hysterical exaggeration definitely proves that he has another problem when wearing a condom and that he tries to hide it! Where is the prevention material that tackles this topic? Let's teach the women the art of dealing with such "psychological" weakness and the technique of reaching pleasure through the latex .or the safe pleasure without latex!

Even more outrageous are those cheaters who say that all condoms are too small for them. Do they expect to persuade us that they have an elephant size? I can easily slip the smallest size condom onto my fist! The real problem is that to be erected is not all that is required; when the organ is not hard enough, the condom is always too small to be easily unrolled.

It is urgent to stop these criminals. It is not the impotence that I condemn (Who never had a breakdown? Who does not become older?) but a certain arrogance not to recognize it and to manage it for what it is. A man who refuses to use a condom is not a true man, even if it is his own wife who asks it! Yes, we should seek to make it possible for any wife to impose the use of condoms without creating a conjugal drama!

Where is the prevention material which tries to actualize the concept of the virility? Where is the prevention that teaches the women to foresee and to manage impotency?

I used the word "criminal". I slipped into ethic. Yes, but grass rooted ethic, not the one coming from the sky. Where are the posters daring to say that a man refusing the use of condoms could be a murder? Would any religious man dare to contradict this basic moral standard?

Now it becomes even more urgent to promote condom rather than conjugal confidence. Although I support, without ambiguousness, all actions promoting fidelity in the marriage, I definitely do not have this cynicism that confounds promotion of fidelity with the prevention of AIDS. In this country alone, there are hundreds of thousands of faithful women and even more orphans who moan it!

Our team , "PrevAIDS", quickly understood what we had to do: create "second line" prevention materials. Some prototypes of giant posters are waiting to be displayed. A few other posters are ready for magazines. We have some VDO clips to offer to TV channels.

But w e immediately faced another problem: who is going to distribute these materials? We definitely do not have money to rent big advertisement boards along the highways; we do not have high-ranked friends to publish and distribute our material in the army barracks, in colleges and at universities; we do not have the required connections to broadcast VDO clips... Who in Thailand is willing to distribute materials that approach topics that may seem controversial? This is not clear. The Thai Red Cross undertakes AIDS - prevention activities, some NGOs also, some hospitals have their own activities, the Ministries of Education and of Public Health are working on their sides, the Prime Minister's office has its own way.

In 1988, I guess that the team of Mr Mechai would directly focus on any new suggestions, analyze them, evaluate the potential impact and eventually include them in its next prevention campaign but now. For all creators involved in AIDS prevention, it is essential to have a prominent advocate and leader to coordinate all resources. Yes! For God's sake, give us an almighty chief! All creative workers will be happy to run with that person and present him allegiance.

While waiting for this "delightful day", we can offer free pages for the magazines concerned about the well being of their readers. We can provide monthly insert to newspapers. If a generous donor can offer to fill an advertisement panel of ten by ten meters at the entry of a city, he will even have the possibility to choose the design that he prefers. Just contact us!